Provider Demographics
NPI:1386647428
Name:DALTON, BRYAN L (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:L
Last Name:DALTON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3100 S ELM PL
Mailing Address - Street 2:STE A
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7950
Mailing Address - Country:US
Mailing Address - Phone:918-455-7777
Mailing Address - Fax:918-455-8105
Practice Address - Street 1:3100 S ELM PL
Practice Address - Street 2:STE A
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7950
Practice Address - Country:US
Practice Address - Phone:918-455-7777
Practice Address - Fax:918-455-8105
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-04-18
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Provider Licenses
StateLicense IDTaxonomies
OK2780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE45338Medicare UPIN